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Model Application Template for the State Children’s Health Insurance Program

Effective Date:

Approval Date: 13 FHIAP premium assistance for the whole family. If this option is chosen, these children are put on the FHIAP reservation list. Families are encouraged to apply for immediate coverage through Healthy Kids ESI or direct coverage under the CHIP state plan. FHIAP premium subsidies range from 50 to 95 percent for adults and 100 percent of the premium for children in this income group. Healthy Kids ESI subsidies are 100 percent for children in this income group. Individuals (adults and children) who enroll in FHIAP are subject to all other cost sharing provisions of the insurance plan. The children in this income group have the option of enrolling in FHIAP, Healthy Kids ESI or CHIP direct coverage (OHP Plus). Children enrolled who choose FHIAP or Healthy Kids ESI can move to State plan direct coverage at any time.

• Healthy Kids ESI Premium Assistance for children in families with incomes above 200 up to and including 300 percent of FPL. Children in families with incomes above 200 percent FPL are not eligible for CHIP OHP Plus. Subsidies are available to children in this income category through Healthy Kids ESI. Sliding scale subsidies are available for children who are able to enroll in the family’s ESI.  Families with incomes above 200 up to and including 250 percent of FPL will pay a maximum of 10 percent of the child’s monthly premium.  Families with incomes above 250 up to and including 300 percent of the FPL will pay a maximum of 15 percent of the child’s monthly premium.  All other cost-sharing is subject to the cost of the employer plan.

• Healthy KidsConnect: This is a private insurance option available to children under the CHIP state plan. Sliding scale subsidies are available to children who enroll in State-approved benefit packages developed and offered by private health insurers. Private insurers are selected through a competitive bid process. Approved benefit plans must be comparable to the CHIP direct coverage (OHP Plus) benefit package. Children in families with incomes above 200 percent FPL are not eligible for CHIP OHP Plus.  Families with incomes above 200 up to and including 250 percent of FPL will pay a maximum of 10 percent of the child’s monthly premium; and  Families with incomes above 250 and 300 percent of the FPL will pay a maximum of 15 percent of the child’s monthly premium.